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Biomedical subjects

F Sebening

Publications and source records attributed to F Sebening.

At least 37 records · Page 2Linked to original sources
PubMed1992

Risk factors for perioperative mortality in children with anomalous origin of the left coronary artery from the pulmonary artery.

The present study was conducted on 33 children (median age at initial cardiac catheterization 0.4 years [0.1 to 11.8]) with anomalous origin of the left coronary artery from the pulmonary artery, without associated hemodynamically significant cardiovascular anomalies, who were treated throughout a period of 18 years in our hospital. A two coronary artery circulation was reestablished in 31 of 33 children. One child died before the intended operation, and in one child the left coronary artery was ligated. There were six operative deaths, five intraoperative and one 12 hours after operation. The purpose of the study was to assess which preoperative clinical and angiographic features were associated with a higher perioperative mortality. The following preoperative factors were associated with a statistically significant higher perioperative mortality: young age at operation (p less than 0.03), left and balanced type of coronary circulation (p less than 0.01), and electrocardiographic signs of extensive acute myocardial infarction, namely, marked ST elevation (greater than or equal to 0.2 mV in at least two leads) (p less than 0.03). Left axis deviation on the electrocardiogram was associated with an extreme right dominant type of coronary circulation (p less than 0.005). The latter was also linked with adequate perfusion of the posterolateral left ventricular wall (p less than 0.005). At autopsy, severe increase of heart weight to two or three times the normal heart weight was established in six of seven children. Thus the perioperative mortality was determined primarily by the extent of myocardial ischemia. This in turn is decisively influenced by the dominant type of coronary circulation and the extent of inter-arterial collateralization. Young age, in addition, proved to be a risk factor for mortality at corrective surgery.

Aortography↗
PubMed1992

The influence of pulmonary artery banding on outcome after the Fontan operation.

Thirty-eight patients were selected from a total of 120 patients who underwent the Fontan operation between 1974 and 1988. They were classified into two groups. Group 1 consisted of 18 patients with previous pulmonary artery banding at a mean age of 7 months (2 days to 59 months), and group 2 comprised 20 patients with native pulmonary stenosis. In group 1, 10 children had tricuspid atresia (seven with normally connected and three with transposed great arteries), six had double-inlet ventricle, and two had complex heart malformations. Group 2 consisted of 12 patients with tricuspid atresia and normally connected great arteries, six with double-inlet ventricle, and two with complex malformations. The following clinical and hemodynamic parameters at cardiac catheterization and cineangiocardiography were determined in both groups before the Fontan operation: age and body surface area, hemoglobin concentration and hematocrit value, atrial and pulmonary artery pressures, end-diastolic pressure of the systemic ventricle, arterial oxygen saturation, pulmonary/systemic flow ratio, end-diastolic volume, ejection fraction and mass of the systemic ventricle, cardiac index, and Nakata index. After the Fontan operation in all patients, the presence or absence of pericardial and pleural effusions, ascites, protein-losing enteropathy, and liver and kidney dysfunction was assessed and the clinical status was classified according to New York Heart Association criteria. All preoperative and postoperative parameters were tested for differences between the two groups, and they were compared with normal values. Hematocrit value was higher in group 2 than in group 1 (57.8% versus 53.1%; p less than 0.05). Ventricular mass index was increased in group 1 when compared with group 2 (125.8 gm/m2 versus 87 gm/m2; p less than 0.05). Severe pericardial effusions in the early postoperative period were significantly more frequent in group 1 and were particularly prevalent in the subgroup with long-standing pulmonary artery banding (p less than 0.01). Subaortic stenosis was observed more frequently in group 1. The remaining parameters were not statistically different between the two groups. We conclude that the significant increment in ventricular mass after pulmonary artery banding may represent a risk for unfavorable outcome after the Fontan operation, which increases with time. Therefore, long-standing pulmonary artery banding as a palliative procedure for candidates for the Fontan operation should be avoided.

Adolescent↗
PubMed1992

[Long-term results of Mustard operation in transposition of the great arteries. Angiographic and nuclear medicine study of ventricular function].

The fate of the right ventricle as systemic ventricle after atrial repair of complete transposition of the great arteries has not been clearly elucidated. In order to assess the long-term results of the Mustard operation in patients with complete transposition of the great arteries we present the clinical data of 23 patients who had been operated in the years 1974 and 1975. Twenty of these patients had simple complete transposition of the great arteries with intact ventricular septum, two had an additional small ventricular septal defect and one an additional left ventricular outflow tract obstruction with a 40 mm Hg systolic pressure gradient. The Mustard operation had been performed at a mean age of 2.2 (1 to 3.7) years. Seventeen of the 23 patients underwent a postoperative hemodynamic study with angiocardiography 1.1 (1 to 1.8) years following surgery. At that time the right ventricular ejection fraction, which had been calculated from biplane angiographic right ventricular volume measurements in twelve patients was 62 (52 to 68) %. However the right ventricle was dilated and the mean enddiastolic volume was 132 (108 to 192) % of normal. In twelve of the 23 patients right ventricular function was reassessed 12.6 (11 to 15.3) years after surgery by Technetium-99m-scintigraphy at rest and in ten of those after exercise with a workload of 2 watt/kg. The mean ejection fraction was 51 (38 to 66) % at rest and 52 (40 to 80) % during exercise. Only three patients had a normal response to exercise, which was defined as an increase of ejection fraction with exercise of more than 5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1991

Significance of the subvalvular apparatus for left-ventricular dimensions and systolic function: experimental replacement of the mitral valve.

To study the significance of the subvalvular apparatus for left-ventricular performance in mitral valve replacement, a new experimental model was developed. In 21 dogs St. Jude prostheses were implanted in the mitral position preserving the chordae tendineae and the papillary muscles by plicating and fixing the mitral leaflets with the prosthesis on the valvular annulus. Flexible steel wires were slung around the chordae tendineae of the anterior and the posterior papillary muscle separately and passed through the left ventricular wall via insulating plastic cannulas. Left-ventricular dimensions and global systolic function were measured during volume loading with blood before and after severance of the chordae tendineae by external application of electrocautery to the steel wires. Thus the heart continued beating without any interference following loss of the subvalvular apparatus. The external left ventricular diameters in the major and minor axis were determined by sonomicrometry. Left-ventricular systolic and diastolic pressures were measured by catheter tip manometers, stroke volume by electromagnetic measurements of flow in the ascending aorta. When the chordae tendineae had been cut, left-ventricular end-diastolic diameters in the major axis were increased ( + 2%), in the minor axis decreased (-1%) at any left-ventricular end-diastolic pressure. Systolic shortening of the major axis diameter was considerably reduced (20-27%) at any left-ventricular end-diastolic pressure following severance of the chordae tendineae. Significant increase of the systolic shortening in the minor axis diameter occurred at preload levels of 3-6 mmHg (15-8%), while at higher left-ventricular end-diastolic pressure of 7-8 mmHg no significant changes were present.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Experience with anatomical correction of transposition of the great arteries (TGA).

During the past seven years, 102 patients with TGA have been operated on using the switch operation. Overall early mortality was 5.9%, late mortality 2.%. Sixty-three newborns had an intact septum and were corrected between the 3th and 35th day after birth, 39 had a ventricular septal defect and/or associated anomalies. All operations were carried out under ECC and deep hypothermia. Myocardial function was recorded intraoperatively by using sonomicrometry. The data demonstrate that adaptation of the left ventricle to the new load conditions should be supported by drugs providing inotropic stimulation and afterload reduction. Mean follow-up time is 32.5 months, no rhythm problems have been recorded during that period, a few children revealed trivial pulmonary or aortic valve stenosis and/or incompetence. The switch operation permits good early results for newborns with TGA and intact septum and TGA with VSD. A decade has to pass in order to judge the long-term results.

Follow-Up Studies↗
PubMed1991

Cyclic motion of ischemic ventricular wall area and hydrodynamics of the blood during ejection.

Analysis of dimensional changes of ischemic left ventricular wall segments evidenced a dilation immediately after onset of ejection; thereafter, contraction appears delayed but almost regular. This biphasic systolic wall motion was correlated in a retrospective study to parameters indicating local intramural disorders, intraventricular load changes, and hydrodynamics of the blood during ejection. Hemodynamic data stored on a 16-track tape recorder were analyzed from 12 consecutive experiments in anesthetized dogs in which the left circumflex coronary artery (LCX) was gradually narrowed (coronary flow restriction greater than or equal to 50%). Left ventricular and aortic pressure, aortic blood velocity (v), acceleration/deceleration (dv/dt), and instantaneous stroke volume (m = integral of v*dt), and segment lengths of normal and ischemic myocardial regions (sonomicrometry) were numerically evaluated with 5 msec resolution. Systolic shortening of the intact myocardium correlates with the diminution of the intraventricular volume during ejection (r greater than 0.98). In contrast, ischemic segments dilate early during systole when the blood is accelerated; the extent of dilation depends on the degree of coronary flow reduction. The time course of lengthening coincides with the development of force F = m*dv/dt (r greater than 0.90) originating from regularly contracting parts of the ventricle. During blood deceleration, ischemic wall segments shorten as F turns to negative (r greater than 0.95). Thus, the wall motion of ischemic myocardial regions is modulated by the hydrodynamic force resulting from acceleration and deceleration of blood consecutively impeding and supporting the systolic function of the ischemic myocardium in the course of ejection.

Animals↗
PubMed1991

Long-term results after right ventricular outflow tract reconstruction with porcine and allograft conduits.

From 1975 to 1989, a total of 353 patients were operated for complex cardiac malformations with impaired pulmonary artery perfusion using 53 non-valved and 300 valved right heart to pulmonary artery conduits. In 108 patients a porcine conduit (Hancock or Carpentier-Edwards) 12-30 mm was used; the age range was 14 days to 37 years (mean 4.3 years) and body weight 2.9-68 kg (mean 15.3 kg). One hundred and ninety-two patients had an allograft of 9-29 mm implanted at the age of 17 days to 26 years (mean 3.8 years), body weight 2.7-73 kg (mean 14.2 kg). So far, 32 of the porcine valved conduits have had to be exchanged 2.5-10.5 years (mean 6.1 +/- 2.1 years) after the first implantation. In 3 patients, reoperated before 1982, another porcine valved conduit was used. After 1982, 29 exchanges were all performed using allografts. The main reason for xenograft conduit malfunction was degeneration and/or calcification of the valves. Some conduits, however, with rather small sizes of 12 and 14 mm had to be exchanged in spite of still sufficient function because the children had "outgrown" the conduit and needed a bigger one. Out of 192 patients with allografts implanted since 1982, so far 5 patients have had to be reoperated 2 months to 6 years (mean 4.6 +/- 2.8 years) after the first operation. The causes of allograft failure were degeneration and, in one case, infection of the conduit. Even though allografts seem to be the conduit of choice for right ventricular outflow tract reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Long-term results after right ventricular outflow tract reconstruction with porcine bioprosthetic conduits.

From 1975 to 1990, a total of 110 patients were operated for complex cardiac malformations with impaired pulmonary artery perfusion using porcine valved right heart to pulmonary artery conduits. Twelve- to 30-mm porcine valved conduits (Hancock or Carpentier-Edwards) were implanted at the age of 4 weeks to 28 years (mean 4.3 years). The patients' body weights were 2.9-68 kg (mean 15.3 kg). Early mortality was 5.5% (six patients), late mortality was 12.7% (14 patients), and 90 patients could be included in this long-term follow-up (426 patient-years). So far, 41 of the conduits had to be exchanged 4 months to 15 years (mean 6.5 years) after the first implantation. Forty-nine of the conduits are still in place. At reoperation, 38 patients received an allograft; three patients, reoperated before 1982, had a second xenograft. The main reason for porcine conduit malfunction was degeneration and/or calcification of the valves. In 11 patients, however, with 12- and 14-mm conduits implanted at a mean age of 3.1 years, a reoperation was necessary after a mean time of 6.8 years because these children had "outgrown" the conduit and needed a bigger one. We conclude that even though allografts seem to be the conduit of choice for right ventricular outflow tract reconstruction, our clinical experience shows that porcine valved conduits can be used just as well since most of them function sufficiently well for as long as 5 to 10 years, and early valve failure is relatively rare.

Adolescent↗
PubMed1990

Preservation versus severance of the subvalvular apparatus in mitral valve replacement: an experimental study.

Preservation of the subvalvular apparatus in mitral valve replacement has been suggested to improve postoperative left ventricular performance. As it is difficult to quantify the change in left ventricular performance clinically, an experimental model was devised to demonstrate the contribution of the subvalvular apparatus to left ventricular function. In eight dogs mitral valve replacement (St. Jude prostheses) was performed, preserving the subvalvular apparatus by plicating the leaflets with the prosthesis on the mitral annulus. Left ventricular function was assessed during volume loading with blood before and after cutting the chordae tendineae by means of electrocautery applied via flexible wires slung around the chordae and exteriorized through the left ventricular wall. Left ventricular internal diameters were measured by sonomicrometry. End-diastolic volume (LVedV) and stroke volume were determined by dye dilution and left ventricular pressure (LVP) by cathter tip manometer. The results showed that after cutting the chordae the heart rate did not differ from the pre-cut values at any LVedP. The peak left ventricular pressure was only significantly reduced at an LVedP of 5 mmHg and minor axis diameters were only increased at an LVedP of 9-12 mmHg. Significant changes were observed, however, in LV dP/dtmax (= maximum rise of LVP) (-15%), major axis end-diastolic diameter (+10%) and systolic shortening (-40%), end-diastolic volume (+18%) and ejection fraction (-16%) at any LVedP, and stroke volume (-24%) at any LVedV.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Multicentric quality assurance in cardiac surgery. QUADRA study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: quality data retrospective analysis).

A method for initiating quality assurance in cardiac surgery was developed multicentrically by a commission of the German Society for Thoracic and Cardiovascular Surgery (QUADRA Study). To appraise the quality of cardiosurgical action, variables were compiled from the preoperative, intraoperative, and postoperative treatment course. The data collection was carried out at the same time as treatment. On the basis of unicentric data profiles, multicentric hospital profiles, and problem profiles, a quality comparison could be carried out and the variability of cardiosurgical action which may occasion interventions could be identified. A reduction of perioperative blood consumption during the study period could be observed in four out of five hospitals as the first result. The data collection also revealed epidemiological features. On average, women were older than men at the time of the heart-valve and coronary operations. To ensure data validity and the organization of quality assurance, a documentation assistant and a specially trained physician are necessary at every cardiovascular surgery center. The multicentric external comparison is indispensable and must be carried out by means of a central data collection, for which intrumental and staff capacities are also to be provided. With modern methods of data processing, an additional and new approach to the improvement of quality in cardiac surgery can thus be made.

Blood Transfusion↗
PubMed1990

Special considerations on primary cardiac tumors in infancy and childhood.

Primary cardiac tumors are rare at all ages and are even less common in infants and children. In the vast majority of cases, they are benign tumors that show little tendency to growth. Primary malignant tumors of the heart are exceptionally rare. Rhabdomyomas are the most common type of tumors in infants, followed in frequency by the fibromas and the teratomas. Myxomas are very rare in pediatric patients. Symptoms that derive from the presence of a neoplastic mass are usually due to obstruction or compression. In young symptomatic patients, usually affected by rhabdomyomas, there is little chance of survival without surgery. On the other hand several patients with cardiac neoplasms are totally asymptomatic. The indication for surgery is differenciated according to the severity of the clinical picture. Since 1974, 15 infants with a cardiac tumor have been observed in our hospital. Our recent experience with 5 cases, which are described in this report, confirm our opinion, that the most important fact is the restoration of the best possible heart function. Total resection of a tumor should not always be the main therapeutical aim. Surgical intervention is required for those patients, who develop relevant clinical symptoms. Close observation of the clinical course is mandatory in all patients with a doubtful indication for operation.

Child, Preschool↗
PubMed1990

Influence of high-dose aprotinin treatment on blood loss and coagulation patterns in patients undergoing myocardial revascularization.

Intraoperative administration of the proteinase inhibitor aprotinin causes reduction in blood loss and homologous blood requirement in patients undergoing cardiac surgery. To ascertain the blood-saving effect of aprotinin and to obtain further information about the mode of action, 40 patients undergoing primary myocardial revascularization were randomly assigned to receive either aprotinin or placebo treatment. Aprotinin was given as a bolus of 2 x 10(6) kallikrein inactivator units (KIU) before surgery followed by a continuous infusion of 5 x 10(5) KIU/h during surgery. Additionally, 2 x 10(6) KIU were added to the pump prime. Strict criteria were used to obtain a homogeneous patient selection. Total blood loss was reduced from 1,431 +/- 760 ml in the control group to 738 +/- 411 ml in the aprotinin group (P less than 0.05) and the homologous blood requirement from 838 +/- 963 ml to 163 +/- 308 ml (P less than 0.05). In the control group, 2.3 +/- 2.2 U of homologous blood or blood products were given, and in the aprotinin group, 0.63 +/- 0.96 U were given (P less than 0.05). Twenty-five percent of patients in the control group and 63% in the aprotinin group did not receive banked blood or homologous blood products. The activated clotting time as an indicator of inhibition of the contact phase of coagulation was significantly increased before heparinization in the aprotinin group (141 +/- 13 s vs. 122 +/- 25 s) and remained significantly increased until heparin was neutralized after cardiopulmonary bypass (CPB).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Clinical experiences and long-term results after surgical treatment of type A thoracic aortic aneurysm].

For aortic aneurysms type A operative treatment is the method of choice. During the past 15 years 128 patients with this diagnosis have been operated on. Early mortality was 22%, 77% of all dissections were emergencies. Main causes of death were multiorgan failure. Up to 117 months 8 patients died late in part due to additional ruptures. 17% of the survivors required reoperation up to 154 months. The probability of survival after 10 years is 0.78, in the group with dissections only 0.4. Therefore close follow-up of this patient group is necessary in order to recognize progression of the disease and induce elective operative treatment.

Adult↗
PubMed1990

[Limits of early ambulation following heart surgery from the surgical point of view].

The definition of early mobilization is not standardized, it varies from hospital to hospital. For the purpose of this study it was defined as the point in time at which a patient, after an operation with extracorporeal circulation, was moved from the intensive care unit to the ward; that mean value was 3.0 days. A number of negative factors could be identified which extended this value. Some of them could possibly be influenced medically, others seemed to be pre-determined and could eventually influence indication for surgery.

Aged↗
PubMed1989

Reduction of homologous blood requirement in cardiac surgery by intraoperative aprotinin application--clinical experience in 152 cardiac surgical patients.

The protease inhibitor aprotinin interacts with plasmin and kallikrein, which are generated in cardiac surgery during cardiopulmonary bypass (CPB). The influence of high-dose aprotinin application (2 million kallikrein inactivator units given i.v. at the beginning of anaesthesia followed by a 500,000 KIU/h infusion throughout the operation and additional 2 millions KIU added to the priming of the oxygenator) on perioperative blood loss and donor blood requirement was studied in 152 adult cardiac surgical patients. This group was compared to 317 patients having cardiac surgery without the application of aprotinin. Aprotinin reduced the homologous blood requirement by 43% (1783 +/- 100 vs 1015 +/- 131 ml, p less than 0.05), while the reduction of postoperative blood loss was 29% (1070 +/- 43 vs 761 +/- 51 ml, p less than 0.05). Fortytwo percent of the aprotinin treated patients completed their hospital stay without having any donor blood transfusion compared to 18% in the group without aprotinin. The blood saving effect was even more pronounced in operations with prolonged perfusion times. Intra- and postoperative complications were equally distributed in both groups. The blood-saving effect of aprotinin may be due to a platelet-preserving effect and/or kallikrein inhibition during CPB. There were no clinically relevant side effects related to aprotinin observed. It is concluded that high dose aprotinin therapy reduces both postoperative blood loss and homologous blood requirement, and therefore the routine application of aprotinin during cardiac surgical procedures is to be recommended.

Aprotinin↗